myWorkCover Claims Service

We believe that employers should pose the safety profile in their organisation and that security is pronounced at all times instead of simply pushing the agenda.

“Early Intervention Is The Key”

Early intervention is required for effective injury management. It is intended to encourage employers and workers to look well outside meeting legal obligations in injury management and to recognise the benefits of actively supporting injury management in the workplace. Returning an injured worker to productive work necessitates far more than paperwork and processes. Positive attitudes, supportive relationships with coworkers and friends, and collaboration among employers, co-workers, doctors, and other stakeholders are regarded as essential.

A workplace injury that necessitated a compensation claim is both time-consuming and emotionally draining. The never-ending form submissions, administration processes, dealing directly with the insurer and WorkCover Authority, injured workers, occupational rehabilitation providers, treating health practitioners, conciliation, and stakeholders were the most difficult for most employers. Not only are case managers constantly changing for a claim, but it is also inconvenient to have to constantly follow up with case managers to ensure that your claim is being managed proactively and that case managers are acting in your best interests.

Because the claim process is complex and difficult to understand, managing workers’ compensation claims can be confusing and stressful for employers. The best claims management practices begin with understanding the complexities of the claims process and ensuring that an injured worker feels empowered and supported throughout the claims process. Consult with the worker and other parties involved, including rehabilitation providers, to develop or be involved in the development of an RTW plan aimed at achieving the injured worker’s timely, safe, and durable RTW, as well as to provide suitable and meaningful duties. From the standpoint of claims management, it is critical to understand these distinctions and employ good management practices to help individuals feel empowered and supported.

Where some claims, the majority of which are common lawsuits, end up in the Supreme Court, you must take time out and appoint a lawyer to settle these claims, which end up costing you more. When weighing the costs of dealing with your Workers’ Compensation claims, it can be beneficial to hire a workers’ compensation specialist to manage your claims. It is a long-term investment that will pay dividends not only by saving you headaches, time, and money but also by lowering the impact on your premiums, as the costs must be carried out for three years for each claim.

What Is Injury Management?

Physical injury or illness can frequently lead to feelings of helplessness and loss of control over one’s circumstances, causing additional harm to one’s psychological well-being. It is critical to recognise that psychological and social factors can have an impact on an injured worker’s recovery. An underlying issue at work (for example, conflict with a coworker) or at home (for example, financial difficulties) can cause a minor injury to spiral out of control and result in a more serious secondary illness, such as stress or depression. Addressing these factors, as well as receiving physical and medical treatment, will result in better recovery and outcomes for injured workers.

Injury management encompasses all activities that have a direct impact on the recovery of an injured worker, such as medical treatment, rehabilitation, returning to work, and stakeholder relationships among those involved. Injury management is a comprehensive, systematic process of reintroducing injured workers to their normal lives. It is highly dynamic and interpersonal, necessitating active collaboration and cooperation from all stakeholders. It emphasises workers, positive attitudes, and supportive workplaces just as much as it does efficient processes. An efficient workplace injury management system will benefit everyone. It means that injured workers’ chances of recovering and returning to their normal lifestyle are improved, as are employers’ benefits from retaining experienced workers, which leads to lower claim costs and WorkCover premiums.

Many employers believe that injury management consists solely of filing a workers’ compensation claim with their insurer and delegating responsibility for managing injured workers and their claims to the insurer. Regardless of whether the claim is for weekly compensation or medical and related expenses, this is not always the case. Employers have the greatest ability to positively influence and shape the injury management process from start to finish by engaging in early intervention and claim management in the majority of cases. Employers who keep in close contact with their injured workers, actively participate in injury management, and understand that injury management is as much about running a successful business as it is about achieving the best possible return to work outcomes for injured workers will succeed.

The size of an organisation, whether large or small, has no bearing on the management of effective injuries. When it comes to workplace injury management, smaller workplaces may have fewer resources and face unique challenges. Smaller employers, on the other hand, can provide a number of benefits, including more flexible and informal work arrangements for injured workers. A shorter chain of command fosters closer relationships by allowing injured workers to communicate directly and frequently with those who make the final decisions. There is no one-size-fits-all solution for injury management. Workplaces must be creative and flexible in order to deal with unpredictability and meet the specific needs of injured workers. Individual circumstances of the injured worker must be taken into account.

Prevention is considered the “optimal strategy” by organisations with successful injury management programs that incorporate workplace health and safety into all aspects of their operations. A workplace health and safety program establishes the foundation for greater positive workplace awareness and commitment to injury prevention. Good workplace health and safety programs not only establish standards but also foster a shared commitment to workers’ health and safety.

The most important aspect of a workplace injury management program is that any injury is reported as soon as possible so that treatment and management can begin. This increases the likelihood of injured workers returning to work sooner, reduces the time required to manage the injury, and reduces the number of days injured workers will be absent from work.

All injuries must be reported (see The Importance of “Notifiable Incidents” Under the Workers’ Compensation OHS Act for more information). Regardless of how serious or minor the injuries were at the time, as well as encouraging workers to report injuries as soon as possible. In addition, you should educate your workers on incident reporting and injury management procedures. This should be incorporated into the new employee orientation program, training sessions, and staff meetings at the company.

When an employee is injured, you must consider what the employee can do based on the severity of the injury and keep the injury management process moving forwards.  It’s necessary to acknowledge that the injured worker may not be able to return to their pre-injury capacity in some cases. Whatever the injured worker’s circumstances, return to work goals must be established for the injury management processes, and positive attitudes must be fostered by ensuring that the employer and injured worker focus on what they “can do” rather than what they “can’t do.” Working together to achieve these goals will boost injured workers’ motivation and confidence because they will not only know and understand where they are heading, but they will also know and understand where they are going.

Employers are responsible for recognising injured workers and allocating suitable obligations to them.
Employers should never force an injured worker into the first set of appropriate duties without consulting them beforehand, as this could jeopardise their recovery. Sufficient duties that do not add value to the workplace or are not meaningful to the worker are likely to result in dissatisfied and unmotivated injured workers, who can influence and cause dissatisfaction among coworkers due to the perception that the injured worker is “not pulling their weight” or is being counterproductive.

myWorkCover Claim Service.

The objective of myWorkCover is to resolve claims for the benefit of all parties involved. Early intervention injury management can help to reduce claim costs, claim frequency, occupational injuries, WorkCover premiums, and the number of days injured workers miss work. Injury management is an essential component of achieving the best possible outcomes for your injured workers and your company. This also contributes to the development of a supportive culture in your organisation, as well as high expectations for all employees.

Our consulting services include the following:

Policy Management:

We review your policy to ensure that your business activity is classified correctly. We examine your company’s structure to see if there are any opportunities to reduce your premium. We ensure that you pay the correct premium by reviewing your remuneration, industry classification, and claims statement. We ensure that your organisation complies with WorkCover legislation in your legislative state to reduce the risk of fines. For budgeting and planning purposes, we can provide future premium projections based on claims costs.

Claims Management:

We assess and manage all workplace injuries that your company has to a resolution. We are aware that any claims decision can have an impact on premiums. Understanding your claims is an important aspect of claims management. Effective claims management and the right strategy will result in claims being resolved and settled sooner, reducing future liabilities and the risk of affecting your premiums.

Case Conferences & Conciliation: 

To ensure a positive outcome for your company and its employees, we will attend claims meetings and conciliation for all adverse decisions made. We communicate with your insurer, review statistical case estimates, and, if necessary, consult with third-party service providers. We can help you find an Occupational Rehabilitation (OR) provider who understands and works with your company, saving you time, and money, and lowering your future liabilities.

Return to Work:

We can provide advice on the “return to work” provision and identify and eliminate any barriers to your workers from returning to work. We focus on effective injury management so your business can have a decrease in costs and claims, whilst creating a supportive workplace culture. We can assist in putting in a Return-to-Work Plan if required.

Stakeholder:

We collaborate with all parties to maintain positive relationships and achieve positive outcomes. Throughout each claim, we provide guidance and support to your organisation and its stakeholders.

What sets myWorkCover apart from others?

Claims management aims to maximise both injured workers’ rehabilitation and return to work (RTW) as well as our clients’ financial sustainability. We have a solid strategy in place to address the barriers to long-term RTW that any injured worker may face. Each injured worker’s short, medium, and/or long-term RTW goals must be determined.

• Understanding the relationship between RTW goals, methods, and our actions, including timeframes, is crucial to removing barriers and achieving a successful RTW rate.

• Receiving and assessing claims, deciding liability and eligibility for compensation as part of the employer’s responsibilities, and selecting, arranging, and reviewing services for injured workers to ensure an early, safe, and sustainable return to work are all difficult tasks.

• We examined and analysed the injured worker’s injury, capabilities, and expectations, as well as potential psychosocial risks and barriers to the injured worker’s rehabilitation and successful RTW.

• Claims management requires evaluating a worker’s right to compensation on a regular basis and taking necessary action, such as discussing termination benefits with the insurer for workers who violate the law.

• The strategy aims to:
  • improve and maximise better outcomes for our clients the efficiency of case management to resolve each claim for our clients
  • increase in workers’ RTW rate
  • minimise the cost of claims to reduce the impact on premiums
  • the length of each claim to reduce the impact on premiums.

In the claim’s life cycle, the preceding approach also aids in the early detection of growing impediments to recovery and RTW. In response to emergent challenges and/or changes in the injured worker’s status, we update or adapt our strategies and actions:

• we monitor and review the worker’s progress
• consult with relevant stakeholders
• seek expert advice when necessary, such as an OR, THP, IME and the insurer

• update our strategies in response to changes:
  • worker’s injury circumstances and mindset
  • decision making – Injured workers’ RTW, recovery, and premiums can all be affected by poor decisions. Poor decision-making, on the other hand, can be avoided by implementing high-quality claims assessment and management procedures and practices on a regular basis.

There will always be times when the insurer makes an unfavourable decision, such as suspending, reducing, or terminating worker’s compensation benefits, which will almost always result in a conciliation through the Accident Compensation Conciliation Service (ACCS). If a worker chooses to refer an adverse decision to conciliation (ACCS), we will attend the conciliation and review the decision, taking into account any new information and attempting to achieve the best possible outcome.

myWorkCover utilises the WorkSafe Claims Manual in managing our client’s claims. To optimise an injured worker’s early, safe, and sustainable RTW and community activities, good case management practice necessitates the active, cost-effective management of each claim. We work to the standards set by the Victorian Auditor-General’s Office. This is what sets myWorkCover Solutions apart from the competition.

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Disclaimer:

The information in this post is strictly for informational and educational purposes only and should not be construed as legal advice. It is not intended to express specific opinions about specific cases. Before acting on any of the issues discussed in this post, seek additional advice. The information provided should not be relied on for any purpose other than to assist you to understand how Workers’ Compensation insurance works. It is for illustrative purposes only and My WorkCover Solutions Pty Ltd does not accept liability for any loss or damage suffered by any person resulting in any way from the use of or reliance on, the information provided. The information in this article is believed to be correct as of the date of publication. However, changes in the applicable laws may have an impact on the accuracy of the material. This article contains general information that is not tailored to any specific person’s situation. This publication may contain information that relates to the regulation of Workers’ Compensation insurance in your State or Territory. To ensure you comply with your legal obligations, we would recommend you refer to the appropriate legislation as currently in force in the State or Territory you conduct your business. You can find up-to-date legislation by visiting each state’s WorkCover Authority website, alternatively contact myWorkCover for updated information.